Always keep on top of your nebulizing equipment. I am currently treating PAP with inhaled GM-CSF through a vibrating mesh nebulizer; the Pari eRapid system to be exact. Over the last few months, I barely noticed the degradation of my treatments as it occurred over such a long period of time. Yet recently, my nebulization time was nearing 10 minutes, which I knew was dramatically longer than when I first purchased my equipment.
I finally replaced my nebulizer's vibrating mesh head and my nebulizing time (for 1.5ml of saline + GM-CSF) was only 2 minutes!
Despite regular cleaning and sanitization, vibrating mesh nebulizers degrade and experience significant performance declines. I have now set up my calendar to automatically remind me every 6 months to replace my nebulizer's vibrating mesh head.